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Groundwater is the most ubiquitous source of liquid freshwater globally, yet its role in supporting diverse ecosystems is rarely acknowledged1,2. However, the location and extent of groundwater-dependent ecosystems (GDEs) are unknown in many geographies, and protection measures are lacking1,3. Here, we map GDEs at high-resolution (roughly 30 m) and find them present on more than one-third of global drylands analysed, including important global biodiversity hotspots4. GDEs are more extensive and contiguous in landscapes dominated by pastoralism with lower rates of groundwater depletion, suggesting that many GDEs are likely to have already been lost due to water and land use practices. Nevertheless, 53% of GDEs exist within regions showing declining groundwater trends, which highlights the urgent need to protect GDEs from the threat of groundwater depletion. However, we found that only 21% of GDEs exist on protected lands or in jurisdictions with sustainable groundwater management policies, invoking a call to action to protect these vital ecosystems. Furthermore, we examine the linkage of GDEs with cultural and socio-economic factors in the Greater Sahel region, where GDEs play an essential role in supporting biodiversity and rural livelihoods, to explore other means for protection of GDEs in politically unstable regions. Our GDE map provides critical information for prioritizing and developing policies and protection mechanisms across various local, regional or international scales to safeguard these important ecosystems and the societies dependent on them.

The association of Comamonas kerstersii with peritonitis resulting from the presence of perforated appendix has previously been described by our research team. In the present study, we describe the isolation of this microorganism from two forms of unusual presentations of C. kerstersii infection not previously described in the literature: localized intra-abdominal infection (psoas abscess) and pelvic peritonitis.

District heating and cooling networks represent a compelling energy system solution due to their capacity to integrate renewable energies and leverage local surpluses of thermal resources. The meticulous design and optimization of network infrastructure are imperative to fully exploiting the potential of these energy systems. The Life Cycle Assessment of district heating and cooling networks for the purpose of environmental sustainability is a crucial and increasingly demanded aspect, particularly in light of the progressively stringent European regulations. The Life Cycle Assessment methodology could offer an evaluation throughout the entire life cycle of such networks. The proposed review scrutinizes the application of the Life Cycle Assessment methodology to evaluating the environmental profile of district heating and cooling systems. The methods, findings, and challenges are examined through a literature review and case study analysis. The results highlight variations in the climate profile influenced by the network generation type and multifunctionality approaches. The analysis revealed a range of emission factors, spanning from 11 gCO2eq/kWhth to 470 gCO2eq/kWhth for district heating and 6 gCO2eq/kWhth to 64 gCO2eq/kWhth for district cooling. The discussion emphasizes integrating district heating and cooling network management considerations and addressing methodological challenges. This study concludes by proposing future research directions for developing a universal LCA-based tool for district heating and cooling network analysis.

The underestimation of precipitation (UoP) in the hilly and mountainous parts of South Asia is estimated by some studies to be as large as the observed precipitation (P). However, UoP has been analyzed to only a limited extent across India. To help bridge this gap, watershed-scale UoP was analyzed using various P datasets within a water imbalance analysis. Among these P datasets, the often-used Indian Meteorological Department (IMD) dataset is of primary interest. The gross UoP was identified by analyzing the extent of the imbalance in the annual water budget of watersheds corresponding to 242 river gauging stations for which quality-controlled data on catchment boundaries and streamflow are available. The water year (WY)-based volume of observed annual P was compared against the observed annual streamflow (R) and the satellite-based actual evapotranspiration (ET). Across many watersheds of both Northern and Peninsular India, spurious water imbalance scenarios (P≤R or P≪R+ET) were realized. It is shown that the management of water, such as groundwater extraction, reservoir storage and water diversion, is generally minimal compared to the annual P in such watersheds. It is also shown that annual changes in terrestrial water storage are minimal compared to the annual P in such watersheds. Assuming that data on R (and, to a lesser extent, ET) are reliable, it is concluded that UoP is very likely the cause of this imbalance. Inter-watershed groundwater flow (IGF) is assumed to be negligible. While the effect of IGF on R is unknown, examples are provided which show that IGF is unlikely to be the cause of the observed imbalance in certain watersheds. All 12 of the P datasets analyzed here suffer from UoP, but the extent of the UoP varies by dataset and region. The reanalysis-based datasets ERA5-Land and IMDAA are less affected by UoP than the IMD dataset. Based on the 30-year period of WY 1985–2014, P for the whole of India could be as much as 19 % (ERA5-Land) to 37 % (IMDAA) higher than that from the IMD, with substantial variability within years and river basins. The actual magnitude of UoP is speculated to be even greater. Moreover, trends seen in the IMD's P are not always present in ERA5-Land and IMDAA. Studies using IMD should exercise caution since UoP could lead to the misrepresentation of water budgets and long-term trends. Limitations of this study are discussed.

Abstract The global terrestrial water storage (TWS), the most accessible component in the hydrological cycle, is a general indicator of freshwater availability on Earth. The global TWS trend caused by climate change is harder to detect than global mean temperature due to the highly uneven hydrological responses across the globe, the brevity of global freshwater observations, and large noises of internal climate variability. To overcome the climate noise and small sample size of observations, we leverage the vast amount of observed and simulated meteorological fields at daily scales to project global TWS through its fingerprints in weather patterns. The novel method identifies the relationship between annual global mean TWS and daily surface air temperature and humidity fields using multi-model hydrological simulations. We found that globally, approximately 50% of days for most years since 2016 have climate change signals emerged above the noise of internal variability. Climate change signals in global mean TWS have been consistently increasing over the last few decades, and in the future, are expected to emerge from the natural climate variability. Our research indicates the urgency to limit carbon emission to not only avoid risks associated with warming but also sustain water security in the future.

Abstract The Tibetan Plateau (TP) is suffering from a substantial decline in terrestrial water storage (TWS) in exorheic basins, threatening water resources that are critical for ∼2 billion people downstream. TWS changes are commonly estimated using gravity satellites through observations of the total terrestrial mass storage (TMS) change, with an implicit assumption of a negligible contribution from sediment transport. Through long‐term (2002–2017) sediment flux observations in seven headwater basins on the TP, we reveal that the gravity satellite‐derived TMS has decreased at a rate of 3.85 ± 0.23 Gt yr−1 in the seven basins, of which 0.35 ± 0.04 Gt yr−1 is contributed by sediment transport. Neglecting this contribution leads to an overestimation of the TWS loss by 10.1 ± 1.3%, equivalent to the annual water demand of an additional 0.62 million people in the surrounding nations. Regionally, the overestimation is surprisingly high in the Indus River and Yarkant River basins, reaching up to 50.8%–77.6%.

El objetivo del trabajo fue evaluar la sensibilidad a antiguos y nuevos antimicrobianos de aislamientos de Staphylococcus aureus resistentes a la oxacilina, de origen hospitalario (SAOR-H) y adquiridos en la comunidad (SAOR-AC), y también en aislamientos sensibles a la oxacilina (SAOS). Se estudió en forma prospectiva la concentración inhibitoria mínima a diversos antimicrobianos en 118 aislamientos consecutivos por dilución seriada en agar según las indicaciones del CLSI. En los aislamientos de SAOR sin resistencia acompañante se determinó la presencia de los genes mec A, leucocidina de Panton Valentine (LPV) y γ-hemolisina por PCR, y del cassette SCC mec por PCR múltiple. De los 118 aislamientos estudiados, 44 fueron SAOR-H, 16 SAOR-AC y 58 SAOS. Los aislamientos de SAOR-H presentaron resistencia simultánea a eritromicina, clindamicina, gentamicina, ciprofloxacina, levofloxacina y moxifloxacina, y todos fueron sensibles a tigeciclina (TIG), vancomicina, teicoplanina y linezolid (LZD). Los aislamientos de SAOR-AC fueron resistentes solamente a OXA y sensibles a todos los antimicrobianos ensayados. En todos ellos se detectaron los genes mec A, LPV, γ-hemolisina y el cassette SCC mec IV. En SAOS y en SAOR-AC todos los antimicrobianos no ß-lactámicos ensayados presentaron excelente actividad in vitro, mientras que en SAOR-H sólo los antiguos antimicrobianos como glucopéptidos, doxiciclina, rifampicina y trimetoprima-sulfametoxazol presentaron buena actividad in vitro, al igual que LZD y TIG entre los nuevos antimicrobianos. El fenotipo de SAOR sin resistencia acompañante fue altamente predictivo de SAOR-AC, ya que fue confirmado por presentar el cassette SCC mec IV.The objective of the study was to evaluate the susceptibility to old and new antimicrobial agents against hospital-acquired oxacillin-resistant Staphylococcus aureus (HA-ORSA), community-acquired oxacillin-resistant S. aureus (CA-ORSA), and oxacillin-susceptible S. aureus (OSSA). The minimum inhibitory concentration of different antimicrobial agents against 118 S. aureus consecutive and prospective isolates was studied by the CLSI agar dilution method. In ORSA isolates without accompanying resistance, the mec- A gene, the Panton-Valentine leukocidin gene (PVL), and the γ-hemolysin gene were determined by PCR, and the SCC cassette mec gene by multiplex PCR. Out of the 118 isolates, 44 were HA-ORSA, 16 were CA-ORSA, and 58 corresponded to OSSA. The HA-ORSA isolates presented simultaneous resistance to erythromycin, clindamycin, gentamicin, ciprofloxacin, levofloxacin, and moxifloxacin whereas all of them were susceptible to tigecycline (TIG), vancomycin, teicoplanin and linezolid (LZD). The CA-ORSA isolates were only resistant to OXA and presented susceptibility to all the antimicrobial agents assayed. In all of them, the mec-A gene, the PVL gene, the γ-hemolysin gene and the SCC cassette mec type IV gene were detected. With the OSSA and CA-ORSA isolates, all the non- β- lactam antimicrobial agents assayed exhibited excellent in vitro activity. However, in the HA-ORSA isolates, only the old antimicrobial agents such as glycopeptides, doxyciclin, rifampin, and trimethoprim-sulfamethoxazole and the new antimicrobial agents LZD and TIG, presented good in vitro activity. The ORSA phenotype without accompanying resistance was highly predictive of CA-ORSA as confirmed by a positive SCC cassette mec type IV.

Entre junio y diciembre de 2004 se estudiaron 33 aislamientos de Acinetobacter baumannii resistentes a los carbapenemes, aislados de materiales clínicos de 29 pacientes internados en la unidad de cuidados intensivos del Hospital de Clínicas de la Universidad de Buenos Aires. La distribución clonal de esos aislamientos fue la siguiente: clon I (n = 14), clon IV (n = 7), clon III (n = 6), clon VI (n = 3), clon II (n = 2) y clon X (n = 1).Veintiún aislamientos se recuperaron de materiales del tracto respiratorio inferior, 11 de ellos pertenecieron al clon I. Casi todos los aislamientos pertenecientes al clon III (5/6) se recuperaron de materiales no respiratorios, y todos los del clon IV se recuperaron de pacientes que no recibieron imipenem. En los aislamientos pertenecientes a los clones I y III se observó una mayor adherencia a catéteres, principalmente en los asociados con bacteriemias. La mayoría de los aislamientos de los clones I y IV sobrevivieron en materiales inertes durante un período superior a los 5 días. La totalidad de los aislamientos del clon III fueron sensibles a colistina, gentamicina y levofloxacina, mientras que los del clon I y la mayoría de los del clon IV sólo fueron sensibles a colistina y tetraciclinas.From June to December 2004, thirty-three carbapenem-resistant Acinetobacter baumannii isolates recovered from twenty nine patients at the intensive care unit in Hospital de Clínicas, Universidad de Buenos Aires, were studied. The isolates were categorized by molecular methods as: clone I (n = 14), clon IV (n = 7), clone III (n = 6), clone VI (n = 3), clone II (n = 2) and clone X (n = 1). Twenty one isolates were recovered from lower respiratory tract samples, 11 of which belonged to clon I. Clone III isolates were mainly recovered from non-respiratory samples (5/6). Clone IV isolates were recovered from patients not receiving previous imipenem therapy. The majority of the isolates belonging to clones I and IV were able to survive on inert materials for more than 5 days, whereas adhesion to catheters was observed in isolates belonging to clones I and III, especially in those related to bacteremia. Clone III isolates showed colistin, gentamicin and levofloxacin susceptibility, whereas clone I isolates and most from clone IV were only susceptible to colistin and tetracyclines.

Los objetivos del trabajo fueron conocer la prevalencia de tricomonosis en pacientes embarazadas y evaluar la utilidad de diferentes metodologías para su diagnóstico. Se estudiaron prospectivamente 223 mujeres embarazadas. Trichomonas vaginalis se investigó utilizando distintos exámenes microscópicos, cultivo en medio sólido y medio líquido. Se evaluó la sensibilidad y especificidad de la microscopía considerando a los cultivos en ambos medios como método de referencia. La prevalencia del parásito obtenida por cultivo (medio líquido más medio sólido) fue de 4,5% (10/223) siendo la detección por examen en fresco, coloración de May-Grunwald Giemsa, fresco con solución acética formolada (SAF)/azul de metileno y por cultivo en medio sólido y líquido de 1,3%, 1,8%, 1,8% y 4,5% respectivamente. La sensibilidad del examen en fresco fue 30%, para el May-Grunwald Giemsa y el SAF/azul de metileno fue 40%. Utilizando conjuntamente los tres exámenes microscópicos, la sensibilidad se elevó al 50% y la especificidad fue 100% para todos los exámenes microscópicos. El cultivo en medio líquido detectó el 100% de los casos positivos , mientras que el medio sólido sólo el 50%. Por la baja sensibilidad de la microscopía para T. vaginalis, en embarazadas asintomáticas recomendamos la utilización del cultivo en medio líquido durante el embarazo, para instaurar un tratamiento precoz.The aim of this study was to conduct a survey regarding the prevalence of trichomoniasis in pregnant patients and to evaluate the utility of different diagnostic methods. Two hundred and twenty three vaginal swab specimens from pregnant women were prospectively examined. Trichomonas vaginalis was investigated by various microscopic examinations, solid culture medium and liquid culture medium. The sensitivity and specificity of microscopy were evaluated by considering both culture media as the "gold standards". The prevalence of T. vaginalis obtained by both culture media (liquid plus solid media) was 4.5% (10/223). The prevalence of T. vaginalis obtained by direct smear, May-Grunwald Giemsa staining, sodium acetate-acetic acid-formalin (SAF)/Methylene blue staining-fixing technique, solid medium and liquid medium was 1.3%, 1.8%, 1.8% and 4.5%, respectively. The sensitivity of the direct smear was 30 %, but for the May- Grunwald Giemsa staining and the SAF/Methylene blue staining-fixing technique was 40%. Considering the three microscopic examinations altogether, the sensitivity rose to 50% and the specificity was 100% for all of them. The solid medium detected only 50% of the positive cases; the liquid medium detected 100%. Due to the low sensitivity obtained with microscopy in asymptomatic pregnant patients, we recommend the use of the liquid medium during pregnancy, in order to provide an early treatment.

Se estudiaron 91 aislamientos de Pseudomonas aeruginosa resistentes a carbapenemes con el objetivo de conocer la prevalencia de metalo-β-lactamasas y evaluar la habilidad del ensayo de inhibición empleando discos de EDTA (1 µmol) en su detección. Se determinó la presencia de carbapenemasas en 10 (11%) de los aislamientos recuperados. La sensibilidad a aztreonam en los aislamientos resistentes a ambos carbapenemes resultó un buen predictor de la presencia de estas enzimas. Dichas carbapenemasas correspondieron a la enzima VIM-2 en tres de ellos y a VIM-11 en otros siete. En todos los casos los genes codificantes de estas enzimas se encontraron localizados en integrones de clase 1 seguidos corriente abajo de genes codificantes de enzimas acetilantes de antibióticos aminoglucosídicos. El ensayo de detección fenotípica de metalo-β-lactamasas empleando discos de EDTA mostró un 100% de especificidad y sensibilidad en la detección de estas enzimas en la población de Pseudomonas aeruginosa analizadas.The present study was conducted to estimate the prevalence of metallo-β-lactamases in 91 consecutive carbapenem resistant Pseudomonas aeruginosa isolates, recovered from inpatients at Hospital de Clínicas in Buenos Aires. Both, phenotypic and genotypic methods detected the presence of carbapenemases in 10 (11%) isolates, corresponding to VIM-11 in 7/10 and VIM-2 in the others. Codifying genes were all included in class 1 integrons, upstream genes coding for aminoglycoside modifying enzymes. One hundred percent sensitivity and specificity was achieved by the metallo-β-lactamases phenotypic screening method using EDTA (1 µmol) disks in the Pseudomonas aeruginosa isolates included in this study. Sensitivity to aztreonam in carbapenem resistant isolates was suspicious of the presence of these enzymes.

Enterobacter spp. es un patógeno intrahospitalario que presenta múltiples mecanismos de resistencia a los antibióticos b-lactámicos. Se caracterizaron fenotípica y genotípicamente las diferentes b-lactamasas presentes en 27 aislamientos consecutivos e ininterrumpidos de Enterobacter spp. (25 Enterobacter cloacae y 2 Enterobacter aerogenes). También se evaluó la habilidad de diferentes métodos fenotípicos para detectar b-lactamasas de espectro extendido (BLEE) en estos microorganismos. En 15/27 aislamientos (63%) se observó resistencia a las cefalosporinas de tercera generación. En 12 de los aislamientos resistentes se detectó un alto nivel de producción de cefalosporinasa cromosómica, siendo 6 de ellos también productores de PER-2. Dicha resistencia en los 3 aislamientos restantes se debió exclusivamente a la presencia de BLEE, PER-2 en 2 de ellos y CTX-M-2 en un caso. Sólo CTX-M-2 se detectó con todas las cefalosporinas probadas en los ensayos de sinergia, utilizando el método de difusión, mientras que cefepima mejoró la detección de PER-2 en 7/8 aislamientos productores de esta BLEE, 4/8 utilizando la prueba de doble disco y 7/8 comparando discos de cefepima con y sin el agregado de ácido clavulánico. El método de dilución empleado solo detectó 1/9 BLEE al comparar las cefalosporinas con y sin el agregado de inhibidor.Enterobacter spp. are becoming increasingly frequent nosocomial pathogens with multiple resistance mechanism to b-lactam antibiotics. We carried out the phenotypic and genotypic characterization of beta-lactamases in 27 Enterobacter spp. (25 Enterobacter cloacae y 2 Enterobacter aerogenes), as well as the ability of different extended spectrum b-lactamase (ESBL) screening methods. Resistance to third generation cephalosporins was observed in 15/27 (63%) isolates. Twelve resistant isolates produced high level chromosomal encoded AmpC b-lactamase; 6 of them were also producers of PER-2. Resistance to third generation cephalosporins in the remaining 3 isolates was due to the presence of ESBLs, PER-2 in 2 cases, and CTX-M-2 in the other. Only CTX-M-2 production was detected with all tested cephalosporins using difusion synergy tests, while cefepime improved ESBLs detection in 7/8 PER-2 producers, 4/8 in the inhibitor aproximation test and 7/8 with double disk test using cefepime containing disk with and without clavulanic acid. Dilution method, including cephalosporins with and without the inhibitor detected 1/9 ESBLs producers.

El objetivo de este trabajo fue la caracterización de aislamientos de Staphylococcus aureus meticilina-resistentes (SAMR), provenientes de diferentes procesos infecciosos de pacientes internados en dos hospitales universitarios. Catorce aislamientos fueron analizados mediante la PCR de secuencias repetitivas (Rep-PCR), la amplificación al azar de ADN polimórfico (RAPD-PCR) y la electroforesis de campo pulsado (PFGE). Encontramos que un clon prevalente de SAMR, sensible a rifampicina, minociclina y trimetoprima-sulfametoxazol (RIF S, MIN S, TMS S) estaba presente en ambos hospitales, reemplazando al clon SAMR y multi-resistente previamente descrito en estos mismos hospitales. En este nuevo clon se detectó el cassette cromosómico estafilocócico SCCmec tipo I.The aim of this study was to characterize methicillin-resistant Staphylococcus aureus (MRSA) isolates recovered from different infectious sites of hospitalized patients at two university hospitals. Fourteen isolates were analyzed by repetitive sequence based PCR (Rep-PCR), randomly amplified polymorphic DNA assay (RAPD-PCR), and pulsed-field gel electrophoresis (PFGE). We found that a prevalent clone of MRSA, susceptible to rifampin, minocycline, and trimethoprim/sulfamethoxazole (RIF S, MIN S, TMS S) was present in both hospitals in replacement of the multiresistant MRSA South American clone, previously described in these hospitals. The staphylococcal chromosomal cassette (SCCmec) type I element was detected in this new clone.

En este documento se elaboraron una serie de recomendaciones para el ensayo, lectura, interpretación e informe de las pruebas de sensibilidad a los antimicrobianos para las enterobacterias aisladas con mayor frecuencia de especímenes clínicos. Se adoptaron como base las recomendaciones del National Committee for Clinical Laboratory Standards (NCCLS) de los EEUU, los de la subcomisión de Antimicrobianos, de la Sociedad Argentina de Bacteriología Clínica (SADEBAC), división de la Asociación Argentina de Microbiología (AAM) y de un grupo de expertos invitados. En él se indican las resistencias naturales de los diferentes miembros que integran la familia Enterobacteriaceae y se analiza la actividad de las diferentes beta-lactamasas cromosómicas, propias de cada especie, sobre las penicilinas, cefalosporinas y carbapenemes. Se recomiendan los antimicrobianos que se deberían ensayar, ubicados estratégicamente, para detectar los mecanismos de resistencia más frecuentes y cuales se deberían informar de acuerdo a la especie aislada, el sitio de infección y el origen de la cepa (intra o extrahospitalario). Se detallan los métodos de "screening" y de confirmación fenotipíca para detectar beta-lactamasas de espectro extendido (BLEE) que son más adecuados a nuestra realidad. Por último, se mencionan patrones infrecuentes de sensibilidad/resistencia que deberían verificarse y los perfiles de sensibilidad que pueden hallarse en las distintas enterobacterias en relación con los probables mecanismos de resistencia. Se debe resaltar que el contenido de este documento debe ser considerado como recomendaciones realizadas por expertos argentinos basadas en una revisión de la literatura y datos personales.Taking into account previous recommendations from the National Committee for Clinical Laboratory Standards (NCCLS), the Antimicrobial Committee, Sociedad Argentina de Bacteriología Clínica (SADEBAC), Asociación Argentina de Microbiología (AAM), and the experience from its members and some invited microbiologists, a consensus was obtained for antimicrobial susceptibility testing and interpretation in most frequent enterobacterial species isolated from clinical samples in our region. This document describes the natural antimicrobial resistance of some Enterobacteriaceae family members, including the resistance profiles due to their own chromosomal encoded beta-lactamases. A list of the antimicrobial agents that should be tested, their position on the agar plates, in order to detect the most frequent antimicrobial resistance mechanisms, and considerations on which antimicrobial agents should be reported regarding to the infection site and patient characteristics are included. Also, a description on appropriate phenotypic screening and confirmatory test for detection of prevalent extended spectrum beta-lactamases in our region are presented. Finally, a summary on frequent antimicrobial susceptibility profiles and their probably associated resistance mechanisms, and some infrequent antimicrobial resistance profiles that deserve confirmation are outlined.

Las infeccionesproducidas por microorganismos multirresistentes son uno de los mayores problemas en los centros asistenciales. Frecuentemente, sólo las polimixinas muestran actividad “in vitro” frente a aislamientos de bacilos gram-negativos resistentes a los carbapenemes. Sin embargo, el National Committee for Clinical Laboratory Standards (NCCLS) no incluye, actualmente, recomendaciones para la realización de las pruebas de sensibilidad para este grupo de antibióticos. Se determinóla actividad de colistín y la correlación entre las pruebas de difusión y dilución de este antibiótico frente a 186 aislamientos contemporáneos en el Hospital de Clínicas “José de San Martín”, siguiendo las recomendaciones generales del NCCLS. Se evaluaron dos puntos de corte: NCCLS 1981 (resistente £ 8 mm y sensible > 11mm) y R. Jones 2001 (resistente £ 11mm y sensible > 14mm). Utilizando el punto de corte del NCCLS 1981 se cometieron los siguientes errores: 0,5% “minor”; 2,2% “major” y 4,4% “very major”, mientras que con el propuesto por R. Jones 2001: 18,9% “minor”; 3,8% “major” y 0,5% “very major”. En conclusión, dado que el punto de corte utilizado por R. Jones 2001 disminuye el error “very major” pero aumenta el “minor” se recomienda la utilización de la concentración inhibitoria mínima (CIM) para confirmar la sensibilidad a colistín cuando sea usada en el tratamiento de infecciones, sin embargo no se detectó resistencia a colistín con halos de inhibición > a 16 mm.Infections produced by multidrug resistant organisms are one of the greatest problems in health centers. Often, only polymyxines show good activity “in vitro” against the carbapenem resistant gram-negative strains; but the National Committee for Clinical Laboratory Standards (NCCLS) documents do not currently provide interpretative criteria for testing the polymyxines.The antimicrobial activity ofcolistin,and the correlation betweenthe agar dilution test and disk diffusion test were evaluated against 186 gram-negative strains isolated at the Hospital de Clínicas “José de San Martín” of Buenos Aires city. All susceptibility tests were performed according to the NCCLS recommendations. Were evaluated two breakpoints, NCCLS 1981 (£ 8mm and >11mm), and R. Jones 2001 (£ 11 mm and > 14 mm). Discrepancies on interpretative category were found (0.5% minor; 2.2% major and 4.4% very major) with NCCLS 1981, and (18.9% minor; 3.8% majorand 0.5% very major) with R. Jones 2001 criteria. Conclusions. In spite of the fact that the breakpoint used by R. Jones 2001decreases the very major error but increases the minor error, according to our results we recommend the use of MIC methods to assist the therapeutic application of colistin; however resistance to colistin was not detected with zone diameters > 16mm.

En el período comprendido entre el 1 de enero y el 31 de diciembre de 2001, se analizaron en ocho hospitales de la ciudad de Buenos Aires, uno de La Plata y en tres del Gran Buenos Aires, 80.141 hemocultivos del Sistema Bact-Alert (14.960 botellas FAN aeróbicas, 3.855 FAN anaeróbicas, 11.114 aeróbicas estándar, 11.367 anaeróbicas estándar, 12.054 pediátricas, 26.791 pediátricas FAN) y 44.235 series que correspondieron a 27.615 pacientes. Se obtuvieron 13.657 hemocultivos positivos. Sólo 181 de ellos desarrollaron entre el 5° y el 7° día. Solamente 26 de los 181 aislamientos (0,19% del total de hemocultivos positivos) tuvieron relevancia clínica (Staphylococcus aureus 3; estafilococos coagulasa negativos 2; Enterococcus faecalis 1; Streptococcus pneumoniae 2; Campylobacter spp 1; Escherichia coli 1; Enterobacter cloacae 1; Enterobacter aerogenes 1; Citrobacter freundii 1; Klebsiella pneumoniae 1; Proteus mirabilis 1; Serratia marcescens 4; levaduras 7, que incluyó a una cepa de Cryptococcus neoformans). Los restantes microorganismos fueron asumidos como contaminantes (Propionibacterium spp 57; difteroides 26; estafilococos coagulasa negativos 32; Bacillus spp 14; Micrococcus spp 4; Acinetobacter lwoffi 6; Acinetobacter spp 1; Acinetobacter baumannii 2; Pseudomonas spp 2; Stenotrophomonas maltophilia 1; Alcaligenes xylosoxidans 1; estreptococos del grupo viridans 2; flora polimicrobiana 2 ). Del total de contaminantes, el 38% desarrolló en la botella anaeróbica estándar (65% de ellos fueron Propionibacterium spp y 29% estafilococos coagulasa negativos), 31,2% en la botella FAN aeróbica (33,3% fueron difteroides y 28,9% Bacillus spp), 11,8% en la pediátrica, 9% en pediátrica FAN, 8,33% en aeróbica estándar y 1,4% en FAN anaeróbica. En este trabajo multicéntrico se demuestra que de rutina no es necesario incubar los frascos del Sistema Bact-Alert por más de 5 días.Between January and December 2001, we analyzed 80,141 blood cultures by the Bact-Alert system (14,960 FAN aerobics, 3,855 FAN anaerobic, 11,114 standards aerobics, 11,367 standards anaerobic, 12,054 pediatrics and 26,791 FAN pediatrics bottles) and 44.235 series from 27.615 patients at eight hospitals of Buenos Aires city, one of La Plata city and three of the Buenos Aires province. A total of 13,657 blood cultures yielded a positive result. Only 181 of them had been detected as positive between the 5th and 7th day of incubation and only 26 (0.19%) had clinical significance (Staphylococcus aureus 3; coagulase negative staphylococci 2; Enterococcus faecalis 1; Streptococcus pneumoniae 2; Campylobacter spp 1; Escherichia coli 1; Enterobacter cloacae 1; Enterobacter aerogenes 1; Citrobacter freundii 1; Klebsiella pneumoniae 1; Proteus mirabilis 1; Serratia marcescens 4; yeasts 7, including one strain of Cryptococcus neoformans). Of the total of contaminants, 38% were isolated by the anaerobic standard (65% were Propionibacterium spp and 29% coagulase negative staphylococci), 31.2% by the FAN aerobic (33.3% difphteroids and 28.9% Bacillus spp), 11.8% by the pediatric, 9% by FAN pediatric, 8.33% by aerobic standard and 1.4% by FAN anaerobic bottle. Our results show that the prolonged incubation of blood cultures for more than 5 days using the Bact-Alert system is unnecessary.

Cemiplimab has demonstrated relevant clinical activity in cutaneous squamous cell carcinoma (cSCC) but mechanisms of primary and acquired resistance to immunotherapy are still unknown. We collected clinical data from locally advanced and/or metastatic cSSC patients treated with cemiplimab in two Italian University centers. In addition, gene expression analysis by using Nanostring Technologies platform to evaluate 770 cancer- and immune-related genes on 20 tumor tissue samples (9 responders and 11 non-responders to cemiplimab) was performed. We enrolled 81 patients with a median age of 82 years. After 16.4 months of median follow-up, 12- and 24-months PFS were 53% and 42%, respectively; while 12- and 24-months OS were 71% and 61%, respectively. Treatment was well tolerated. Overall response rate (ORR) was 58%, with a disease control rate (DCR) of 77.8%. The difference between genes expressed in responder versus non-responder patient samples was substantial, particularly for genes involved in immune system regulation. Cemiplimab-resistant tumors were associated with over-expression of CCL-20 and CXCL-8. Cemiplimab confirmed efficacy and safety data in real-life cSCC patients. Overexpression of CCL-20 and CXCL-8 could represent biomarkers of lack of response to immunotherapy.

The article aims to reconstruct the public debate taking place in San Lorenzo, a neighbourhood close to Rome city centre. Its data come from direct observation and interviews, mainly with activists from different associations who express differing positions on a variety of themes concerning the present and future of the area. These range from security and decorum issues to urban and economic development. How to address these themes will clearly have repercussions on the quality of public space, from both physical and social points of view.In the decades following WWII San Lorenzo was a traditional working-class area, which subsequently underwent deindustrialization and decline in handicraft activities. It is also very close to Rome’s main University campus, with the presence of students enlivening a vibrant nightlife. Consequently, the district’s economy has progressively geared towards entertainment services. In the last few years, however, the so-called movida has been attracting youngsters and teenagers from all over the metropolis, rendering night rest particularly problematic for residents.Research highlights two camps into which the associations in San Lorenzo can be divided: civic associations and radical Social centres. These groups propose competing general views of the desired trajectory of change in the district that can be seen to amount to two alternative definitions of quality public space. Finally, it is shown that the action of radical social centres is unable to construct a conflict and the sociological meaning of this assertion is discussed.

We describe four isolates of Ng from men who have sex with men (MSM) patients that were able to grow in theabscense of CO2, as previously was described for N. gonorrhoeae ssp. kochii. These isolates were able to grow aerobically (without any added CO2) at 37 °C giving small colonies after 48 hs; two of them isolated from pharynx and urethraof one patient,were also able to grow without the blood supplement in the same conditions. In these unusualisolates the major outer-membrane proteins are of the same molecular weight than Ng. These isolates could be taken for other members of the genus if not confirmed by means of these (or other) methods.Cuatro aislamientos de Neisseria gonorrhoeae recuperados de muestras extragenitales de pacientes homosexuales masculinos fueron capaces de crecer en en medio sólido en ausencia de CO2 en aerobiosis, tal como ya fue descrito para N. gonorrhoeae sub-especie kochii, dando origen a pequeñas colonias luego de 48 hs de incubación a 37 °C. Mas aún, dos de los aislamientos (aislados de uretra y faringe del mismo paciente) fueron capaces de crecer sin el agregado del suplemento de sangre. En estos aislamientos, los perfiles de proteínas de envoltura externa fueron idénticos a los de aislamientos genitales de la misma especie. Este hallazgo refuerza la necesidad de lograr una identificación cierta de estos microorganismos, ya que los esquemas simplificados hubieran llevado a su identificación errónea como N. meningitidis o su confusión con otras especies del género.

The 1980 Ms 6.9 Irpinia earthquake was responsible for the activation or reactivation of numerous gravitative deformations mainly hosted by clayey lithotypes, affecting wide areas of Benevento Province and the Sele and Ofanto R. Valleys. The case of Calitri offers valuable insights into a methodological approach to studying mass movements affecting human settlements. Post-earthquake investigations in Calitri involved extensive geognostic boreholes and in situ surveys, providing substantial data for lithological characterization and landslide modeling. Additionally, over the past two decades, satellite-based techniques have supported the mapping and characterization of ground deformations in this area, improving our understanding of spatiotemporal evolution. Despite these efforts, a detailed subsurface comprehensionof the tectono-stratigraphy and geometriesof gravity-induced deformation remains incomplete. This study aims to enhance our knowledge of gravity-driven deformations affecting urban areas by using deep-penetrating GroundPenetrating Radar (GPR) surveys to identify landslide-related structures, rupture surfaces, and lithological characterization of the involved lithotypes. The integration of GPR surveys with classical morphotectonic analysis led to the delineation of the main subsurface discontinuities (stratigraphy, tectonics, and gravity-related), correlating them with available geognostic data. This approach provided non-invasive, detailed insights into subsurface features and stands out as one of the rare case studies in Italy that employed the GPR method for landslide investigations.

Evaporation (ET) is one of the crucial components of the water cycle, which serves as the nexus between global water, energy, and carbon cycles. Accurate quantification of ET is, therefore, pivotal in understanding various earth system processes and subsequent societal applications. The prevailing approaches for ET retrievals are either limited in spatiotemporal coverage or largely influenced by the choice of input data or simplified model physics, or a combination thereof. Here, using an independent mass conservation approach, we develop water-balance-based ET datasets (ET-WB) for the global land and the selected 168 major river basins. We generate 4669 probabilistic unique combinations of the ET-WB leveraging multi-source datasets (23 precipitation, 29 runoff, and 7 storage change datasets) from satellite products, in situ measurements, reanalysis, and hydrological simulations. We compare our results with the four auxiliary global ET datasets and previous regional studies, followed by a rigorous discussion of the uncertainties, their possible sources, and potential ways to constrain them. The seasonal cycle of global ET-WB possesses a unimodal distribution with the highest (median value: 65.61 mm per month) and lowest (median value: 36.11 mm per month) values in July and January, respectively, with the spread range of roughly ±10 mm per month from different subsets of the ensemble. Auxiliary ET products illustrate similar intra-annual characteristics with some over- or underestimation, which are completely within the range of the ET-WB ensemble. We found a gradual increase in global ET-WB from 2003 to 2010 and a subsequent decrease during 2010–2015, followed by a sharper reduction in the remaining years primarily attributed to the varying precipitation. Multiple statistical metrics show reasonably good accuracy of monthly ET-WB (e.g., a relative bias of ±20 %) in most river basins, which ameliorates at annual scales. The long-term mean annual ET-WB varies within 500–600 mm yr−1 and is consistent with the four auxiliary ET products (543–569 mm yr−1). Observed trend estimates, though regionally divergent, are evidence of the increasing ET in a warming climate. The current dataset will likely be useful for several scientific assessments centering around water resources management to benefit society at large. The dataset is publicly available in various formats (NetCDF, Mat, and Shapefile) at https://doi.org/10.5281/zenodo.8339655 (Xiong et al., 2023).

Abstract Women with germline pathogenic variants in CDH1, which encodes E-cadherin protein, are at increased lifetime risk of invasive lobular carcinoma (ILC). The associated tumor characteristics of hereditary lobular breast carcinoma (HLBC) in this high-risk population are not well-known. A single-center prospective cohort study was conducted to determine the imaging and pathologic features of HLBC compared to population-based ILC using Surveillance, Epidemiology, and End Results (SEER) data. One hundred fifty-eight women with CDH1 variants were evaluated, of whom 48 (30%) also had an ILC diagnosis. The median age at CDH1 diagnosis was 45 years [interquartile range, IQR 34–57 years] whereas the median age at diagnosis of CDH1 with concomitant ILC (HLBC) was 53 [IQR 45–62] years. Among women with HLBC, 83% (40/48) were identified with CDH1 mutation after diagnosis of ILC. Among 76 women (48%, 76/158) undergoing surveillance for ILC with breast magnetic resonance imaging (MRI), 29% (22/76) had an abnormal MRI result with available biopsy data for comparison. MRI detected ILC in 7 out of 8 biopsy-confirmed cases, corresponding with high sensitivity (88%), specificity (75%), and negative predictive value (98%); however, false-positive and false-discovery rates were elevated also (25% and 68%, respectively). HLBC was most frequently diagnosed at age 40–49 years (44%, 21/48), significantly younger than the common age of diagnosis of ILC in SEER general population data (most frequent age range 60–69 years, 28%; p

The US Northern Great Plains and the Canadian Prairies are known as the world's breadbaskets for their large spring wheat production and exports to the world. It is essential to accurately represent spring wheat growing dynamics and final yield and improve our ability to predict food production under climate change. This study attempts to incorporate spring wheat growth dynamics into the Noah-MP crop model for a long time period (13 years) and fine spatial scale (4 km). The study focuses on three aspects: (1) developing and calibrating the spring wheat model at a point scale, (2) applying a dynamic planting and harvest date to facilitate large-scale simulations, and (3) applying a temperature stress function to assess crop responses to heat stress amid extreme heat. Model results are evaluated using field observations, satellite leaf area index (LAI), and census data from Statistics Canada and the United States Department of Agriculture (USDA). Results suggest that incorporating a dynamic planting and harvest threshold can better constrain the growing season, especially the peak timing and magnitude of wheat LAI, as well as obtain realistic yield compared to prescribing a static province/state-level map. Results also demonstrate an evident control of heat stress upon wheat yield in three Canadian Prairies Provinces, which are reasonably captured in the new temperature stress function. This study has important implications in terms of estimating crop yields, modeling the land–atmosphere interactions in agricultural areas, and predicting crop growth responses to increasing temperatures amidst climate change.

Abstract On 8 September 2023 an MW 6.8 earthquake struck the High Atlas Mountains of western Morocco, about 70 km southwest from Marrakesh, causing significant devastation and casualties. In this study, we investigate a comprehensive geodetic data set, employing interferometric synthetic aperture radar measurements to assess the fault segment responsible for the seismic event. Our findings suggest two potential fault scenarios: either a transpressive NNW‐dipping high‐angle (70°) fault related to the Tizi n'Test alignment or a transpressive SSW‐dipping low‐angle (22°) fault associated with the North Atlas Fault, with slip (up to 2.2 m) only occurring on deeper parts of the fault. While seismic catalogs couldn't definitively determine the dip direction of the fault, evidence from mainshock locations, gravity and heat flow data and modeling, and active shortening direction suggest the activation of a low‐angle south‐westerly dipping oblique thrust of the North Atlas fault during the 2023 Moroccan earthquake.

Abstract The rechallenge strategy is based on the concept that a subset of patients with RAS wild‐type (WT) metastatic colorectal cancer (mCRC) could still benefit of epidermal growth factor receptor (EGFR) inhibition, after progression to an anti‐EGFR based‐therapy. We performed a pooled analysis of two‐phase II prospective trials to determine the role of rechallenge in third‐line mCRC patients with RAS/BRAF WT baseline circulating tumor DNA (ctDNA). Individual data of 33 and 13 patients from CAVE and CRICKET trials that received as third‐line therapy cetuximab rechallenge were collected. Overall survival (OS), Progression‐free survival (PFS), Overall response rate (ORR), Stable disease (SD) >6 months were calculated. Adverse events were reported. For the whole 46 patient population, median PFS (mPFS) was 3.9 months (95% Confidence Interval, CI 3.0–4.9) with median OS (mOS) of 16.9 months (95% CI 11.7–22.1). For CRICKET patients, mPFS was 3.9 months (95% CI 1.7–6.2); mOS was 13.1 months (95% CI 7.3–18.9) with OS rates at 12, 18, and 24 months of 62%, 23%, and 0%, respectively. For CAVE patients, mPFS was 4.1 months (95% CI 3.0–5.2); mOS was 18.6 months (95% CI 11.7–25.4) with OS rates at 12, 18, 24 months of 61%, 52%, 21%, respectively. Skin rash was more frequently reported in CAVE trial (87.9% vs. 30.8%; p = 0.001), whereas a increased incidence of hematological toxicities was observed in CRICKET trial (53.8%% vs. 12.1%; p = 0.003). Third‐line cetuximab rechallenge in combination with either irinotecan or avelumab in RAS/BRAF WT ctDNA mCRC patients represents a promising therapy.

At depths of over 500 m, deep groundwater has long residence times and likely contributes less than 0.1% to global streamflow and only sporadically connects with the surface terrestrial water cycle on geological timescales, according to estimates derived from the chloride mass balance approach.

Continental-to global-scale hydrologic and land surface models increasingly include representations of the groundwater system. Such large-scale models are essential for examining, communicating, and understanding the dynamic interactions between the Earth system above and below the land surface as well as the opportunities and limits of groundwater resources. We argue that both large-scale and regional-scale groundwater models have utility, strengths, and limitations, so continued modeling at both scales is essential and mutually beneficial. A crucial quest is how to evaluate the realism, capabilities, and performance of large-scale groundwater models given their modeling purpose of addressing large-scale science or sustainability questions as well as limitations in data availability and commensurability. Evaluation should identify if, when, or where large-scale models achieve their purpose or where opportunities for improvements exist so that such models better achieve their purpose. We suggest that reproducing the spatiotemporal details of regional-scale models and matching local data are not relevant goals. Instead, it is important to decide on reasonable model expectations regarding when a large-scale model is performing "well enough"in the context of its specific purpose. The decision of reasonable expectations is necessarily subjective even if the evaluation criteria are quantitative. Our objective is to provide recommendations for improving the evaluation of groundwater representation in continental-to global-scale models. We describe current modeling strategies and evaluation practices, and we subsequently discuss the value of three evaluation strategies: (1) comparing model outputs with available observations of groundwater levels or other state or flux variables (observation-based evaluation), (2) comparing several models with each other with or without reference to actual observations (model-based evaluation), and (3) comparing model behavior with expert expectations of hydrologic behaviors in particular regions or at particular times (expert-based evaluation). Based on evolving practices in model evaluation as well as innovations in observations, machine learning, and expert elicitation, we argue that combining observation-, model-, and expert-based model evaluation approaches, while accounting for commensurability issues, may significantly improve the realism of groundwater representation in large-scale models, thus advancing our ability for quantification, understanding, and prediction of crucial Earth science and sustainability problems. We encourage greater community-level communication and cooperation on this quest, including among global hydrology and land surface modelers, local to regional hydrogeologists, and hydrologists focused on model development and evaluation.